连续性静脉-静脉血液透析滤过串联血液灌流HA380治疗15例热射病合并多器官功能障碍综合征患者的疗效观察  

Observation on the efficacy of continuous veno-venous hemodia-filtration combined with hemoperfusion HA380 in the treatment of 15 cases of heat stroke with multiple organ dysfunction syndrome

作　　者：黄玉琴 龙磊 黄强 汪群博 靳科 鞠涛 戴璐婷 徐化强 汪文国 周权 Huang Yuqin;Long Lei;Huang Qiang;Wang Qunbo;Jin Ke;Ju Tao;Dai Luting;Xu Huaqiang;Wang Wenguo;Zhou Quan(Department of Intensive Care Unit,Suizhou Central Hospital,Hubei University of Medicine,Suizhou 441300,Hubei,China)

机构地区：[1]随州市中心医院/湖北医药学院附属随州医院重症医学科,湖北随州441300

出　　处：《中华危重病急救医学》2024年第5期532-537,共6页Chinese Critical Care Medicine

基　　金：湖北省重点研发计划项目(2022BCE058)。

摘　　要：目的探讨连续性静脉-静脉血液透析滤过(CVVHDF)串联HA380血液灌流(HP)治疗热射病合并多器官功能障碍综合(MODS)患者的临床疗效。方法采用回顾性观察性研究方法,将2022年7月至9月就诊于随州市中心医院/湖北医药学院附属随州医院重症医学科的15例热射病合并MODS患者作为研究对象。15例患者均在重症综合管理策略的基础上采取CVVHDF串联HA380血液灌流器治疗。收集患者器官功能指标〔包括总胆红素(TBil)、天冬氨酸转氨酶(AST)、肌酸激酶(CK)、乳酸脱氢酶(LDH)、肌酐(Cr)、心肌肌钙蛋白T(cTnT)、肌红蛋白(Myo)、肌酸激酶同工酶(CK-MB)、序贯器官衰竭评分(SOFA)〕和炎症指标〔包括白细胞计数(WBC)、中性粒细胞计数(NEU)、C-反应蛋白(CRP)、降钙素原(PCT)、白细胞介素-6(IL-6)〕,对比患者在入院时、第1次HP后、第2次HP后、第3次HP后、治疗第5天上述指标的改善情况,结合患者的临床结局评估CVVHDF串联HA380治疗重症热射病的综合疗效。结果15例患者中男性10例,女性5例;平均年龄(64.5±11.5)岁;经典型热射病6例,劳力型热射病9例;入院时格拉斯哥昏迷评分(GCS)3~8分;入院12 h内SOFA评分9~17分;入院24 h内急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)25~45分。治疗后IL-6水平和SOFA评分逐渐下降,第2次HP后即较入院时下降差异有统计学意义〔IL-6(ng/L):48.37(15.36,113.03)比221.90(85.87,425.90),SOFA(分):8.3±3.3比11.1±2.4,均P<0.05〕。PCT水平在第1次HP后达到峰值〔12.51(6.07,41.65)μg/L〕,随后逐渐降低,第3次HP后〔1.26(0.82,5.40)μg/L〕即较第1次HP后差异有统计学意义(P<0.05)。与入院时相比,第1次HP后Cr水平即明显改善(μmol/L:66.94±25.57比110.80±31.13,P<0.01);第2次HP后Myo即明显下降〔μg/L:490.90(164.98,768.05)比3000.00(293.00,3000.00),P<0.05〕;第3次HP后CK水平也得到明显改善〔U/L:476.0(413.0,922.0)比2107.0(729.0,2449.0),P<0.05〕。经过CVVHDF串联3次HP治�Objective To investigate the clinical efficacy of continuous veno-venous hemodia-filtration(CVVHDF)combined with hemoperfusion(HP)HA380 in the treatment of heat stroke patients with multiple organ dysfunction syndrome(MODS).Methods A retrospective and observational study was conducted.A total of 15 patients with heat stroke combined with MODS who were admitted to the department of intensive care unit(ICU)of Suizhou Central Hospital/Hubei University of Medicine from July to September 2022 were selected as the study objects.All 15 patients were treated with CVVHDF combined with HA380 based on the comprehensive management strategy for severe illness.Organ function indicators[including total bilirubin(TBil),aspartate aminotransferase(AST),creatine kinase(CK),lactate dehydrogenase(LDH),creatinine(Cr),cardiac troponin T(cTnT),myoglobin(Myo),MB isoenzyme of creatine kinase(CK-MB),sequential organ failure assessment(SOFA)]and inflammatory indicators[including white blood cell count(WBC),neutrophil count(NEU),C-reactive protein(CRP),procalcitonin(PCT),and interleukin-6(IL-6)]were collected.The improvements of the above indexes at admission,after the first HP,after the second HP,after the third HP,and on the 5th day of treatment were compared.Combined with the clinical outcome of patients,the comprehensive efficacy of CVVHDF combined with HA380 in the treatment of severe heat radiation disease was evaluated.Results There were 10 males and 5 females among the 15 patients.The average age was(64.5±11.5)years old.There were 6 cases of classical heat stroke and 9 cases of exertional heat stroke.Glasgow coma scale(GCS)was 3-8 at admission;SOFA score was 9-17 within 12 hours after admission;acute physiology and chronic health evaluationⅡ(APACHEⅡ)was 25-45 within 24 hours after admission.After treatment,the IL-6 level and SOFA score gradually decreased,and there were significant differences in the decrease after the second HP compared to admission[IL-6(ng/L):48.37(15.36,113.03)vs.221.90(85.87,425.90),SOFA:8.3±3.3 vs.11.1±2.

关 键 词：热射病 血液灌流 多器官功能障碍综合征 类脓毒症反应 

分 类 号：R594.1[医药卫生—内科学]